“Think like a wise man but communicate in the language of the people.”
- William Butler Yeats - Irish poet
Just as cleansing snowfalls, cooler breezes, and overcast skies accompany January into the New Year, revenue cycle change is sure to follow. All of us play a valuable role in the success of increasing quality while decreasing cost as we analyze documentation and assign appropriate codes. Centers for Medicare and Medicaid Services (CMS) have provided the healthcare road map. It is up to us to understand, communicate and carry out the plan.
As we march forward together, clear, concise, crisp, timely, communication is necessary. The tasks are requiring more detail and the skills are becoming more defined. We seek 100% accuracy and learn daily from feedback to be the best we can be. Resolve in 2017 to thrive with the flow of information and ideas that catapult us into new revenue cycle horizons as we collaborate and communicate together.
Beginning the New Year revisiting HIV/AIDS:
- Human immunodeficiency virus (HIV) is a virus transmitted through contact with bodily fluids (blood, semen, vaginal secretions, breast milk) containing infected plasma or cells. Being HIV positive from a blood test showing HIV antibodies is not the same as having human immunodeficiency virus disease (AIDS). “Do not use [code Z21] Asymptomatic human immunodeficiency virus infection status if the term ‘AIDS’ is used or if the patient is treated for any HIV-related illness or is described as having any condition(s) resulting from his/her HIV-positive status; use [code B20] human immunodeficiency virus disease in these cases.”
- “When an OB patient is identified as having an HIV infection a [code from subcategory O98.7] is assigned with [code B20] assigned as an additional code. If an OB patient tests positive for HIV but has no symptoms and no history of an HIV infection, [codes O98.7- and Z21] are assigned rather than [code B20].”
- 4 encounter for screening for HIV
- 7 HIV counseling
- 89 other problems related to lifestyle (high-risk group for HIV infection)
- 6 contact with and suspected to HIV
- [Code B20] is NOT assigned when the diagnostic statement indicates that the infection is “suspected,” “possible,” “likely,” or “questionable”. This is an EXCEPTION to the general guideline that directs the coder to assign a code for a diagnosis qualified to ‘suspected” or “possible” as if it were established. Confirmation, in this case, does not require documentation of positive serology or culture for HIV, the provider’s diagnostic statement that the patient is HIV-positive or has an HIV-related illness is sufficient. The provider should be asked to state the diagnosis in positive terms.
- Once the patient is diagnosed with AIDS, HIV-related disease [code B20], the patient is always reported as AIDS, HIV [code B20] related disease; not returned to the HIV status [code Z21]. “Patients with any known prior diagnosis of an HIV-related illness should be [coded to B20]. Once a patient has developed an HIV-related illness, the patient should always be assigned [code B20] on every subsequent admission/encounter.”
- Q: A patient with AIDS was treated in this hospital last year for AIDS-related histoplasmosis. He is now admitted for acute nephritis. In the record, there is no clear statement that the nephritis is due to his AIDS.
- What is the PDX?
- A: Assign [N00.9] nephritis NOS as the PDX as there is no clear statement that nephritis is an HIV-related disease. The coder should not make such assumptions without clear indications within the record. [Code B20] should be listed as an additional diagnosis. Coding Clinic 4Q 1994 p.35
- Q: An AIDS patient is admitted for treatment of severe diarrhea and dehydration. He is diagnosed to have Cryptosporidiosis with dehydration. How should this be sequenced?
- A: Assign [B20], [A07.2], [E86.0]. Coding Clinic 4Q 1997 p. 30,31
- When documentation is unclear or conflicting, the provider must be queried for clarification.
I look forward to working alongside each of you, researching and supporting all the efforts that go into fulfilling a valued and respected profession, coder. Greet each day with a smile of exhilaration and passion.
About the Author
Marie Thomas holds a Masters in Healthcare Administration from Pfeiffer University, Charlotte, NC, and a Bachelor of Science in Healthcare Administration from Pfeiffer University. Marie has furthered her career education by becoming an AHIMA-Approved ICD-10-CM/PCS Trainer and Ambassador as well as earning the RHIT, CCS, CCDS, and CPC-H credentials. For more information please email us at firstname.lastname@example.org